Acute pseudomonas mastoiditis in children

Five children with acute pseudomonas mastoiditis were treated and followed up in our medical center during a period of three years. The main clinical features of the disease include predilection for young male infants, a high rate of local aggressiveness, prolonged hospitalization for repeated surgical procedures, and the need for several courses of intravenous specific antimicrobial therapy. Although correctly diagnosed and promptly treated, these patients may be destined to chronic ear disorders.     

Acute mastoiditis in children: a review of 54 cases

Fifty-four children with acute mastoiditis were managed at the Los Angeles County-University of Southern California Medical Center from 1972 through 1982. Our criteria for the diagnosis of acute mastoiditis are acute or subacute otitis media, postauricular swelling and erythema, protrusion of the auricle, and clouding of mastoid air cells on radiographs. Thirty-one (57%) recovered with conservative therapy consisting of early myringotomy and intravenous antibiotic, usually ampicillin. Twenty-three patients were managed surgically. The indication for surgery in each case was the clinical diagnosis of subperiosteal abscess; mastoid radiographs played no part in the decision to operate. Two of the 23 patients managed surgically had only incision and drainage of abscess; simple mastoidectomy was performed on 20 and radical mastoidectomy on one. Etiologic bacteria were cultured in 21 instances, S. pyogenes was cultured in 9, S. pneumoniae was cultured in 6, H. influenzae in 1, enterococci in 1, anaerobes in 2, and M. tuberculosis in 2.     

Acute mastoiditis in children with a cochlear implant

ObjectivesCochlear implantation is performed at a young age, when children are prone to acute otitis media. Acute mastoiditis is the most common complication of otitis media, but data on its management in the presence of a cochlear implant are sparse. The objective of this study was to assess the characteristics, treatment, and outcome of acute mastoiditis in children with a cochlear implant.MethodsThe medical files of all children who underwent cochlear implantation at a pediatric tertiary medical center in 2000–2014 were retrospectively reviewed. Those diagnosed with acute mastoiditis after implantation were identified, and data were collected on demographics, history, presentation, method of treatment, complications, association with untreated otitis media with effusion, and long-term middle-ear sequelae.ResultsOf the 370 children (490 ears) who underwent cochlear implantation, 13 (3.5%) were treated for acute mastoiditis (median age at acute mastoiditis, 32 months). Nine had a pre-implantation history of chronic secretory or acute recurrent otitis media, and 5 had been previously treated with ventilation tubes. In all 9 children who had unilateral cochlear implant, the acute mastoiditis episode occurred in the implanted ear. The time from implantation to mastoiditis was 5–61 months. The same treatment protocol as for normal-hearing children was followed, with special attention to the risk of central nervous system complications. Primary treatment consisted of myringotomy with intravenous administration of wide-spectrum antibiotics. Surgical drainage was performed in 8 out of 13 patients, with (n = 7) or without (n = 1) ventilation-tube insertion, to treat subperiosteal abscess or because of lack of symptomatic improvement. There were no cases of intracranial complications or implant involvement or need for a wider surgical approach. No middle-ear pathology was documented during the average 3.8-year follow-up.ConclusionsThe relatively high rate of acute mastoiditis and subperiosteal abscess in children with a cochlear implant, predominantly involving the implanted ear, supports the suggestion that recent mastoidectomy may be a risk factor for these complications. Despite the frequent need for drainage, more extensive surgery is usually unnecessary, and recovery is complete and rapid. As infections can occur even years after cochlear implantation, children with otitis media should be closely followed, with possible re-introduction of ventilation tubes.     

Acute and latent mastoiditis in children

During the period from 1974 to 1981, surgery for acute mastoiditis was performed on 12 ears, giving an annual incidence of 0.004 per cent among cases of acute otitis media. All ears made a full long-term recovery. The low incidence is ascribed to the world-wide early use of antibiotics. During the same period 52 ears with secretory otitis media (SOM) underwent mastoidectomy. Histologically extensive mastoid inflammation was found in 96 per cent. The changes appeared as formation of secretory cells and cysts, resorption of bone, and infiltration of soft tissues with both mononuclear cells and polymorphonuclear leucocytes. The number of SOM patients undergoing mastoid operations account for 1.4 per cent of the patients admitted to hospital because of SOM. Thirty-four ears (65 per cent) have healed during the follow-up period (mean 2.9 years), while the tympanostomy tube is still in place in 18 ears (35 per cent). In the latter group, factors causing oedema in the pharyngeal end of the Eustachian tube are apparently still present.     

Acute mastoiditis in children: a retrospective study of 188 patients

Objective

The aim of this study is to define the clinical and bacteriological characteristics of acute mastoiditis (AM) in children in order to optimize diagnostic work-up and treatment.

Methods

In this retrospective study, 188 children between 3 months and 15 years of age (15 ± 24 months; median ± SD) were referred to our pediatric ENT emergency center for AM during a 7-year period (December 2001-January 2008).

Results

Fifty seven percent were male and 43% were female. Clinical follow-up duration was 3.9 ± 0.7 months (mean ± SEM). The incidence of AM remained stable during the whole study period. Microbiological samples (n = 236) were negative in 33% of cases. The most frequently isolated germs were Streptococcus pneumoniae (51%), Streptococcus pyogenes (11.5%), Anaerobes (6.5%), and coagulase-negative Staphylococcus (6.5%). Paracentesis, puncture of retro auricular abscess under local anesthesia, and peroperative samples all contributed to isolate the involved germ(s). All the patients were hospitalized and received intravenous antibiotics, and 36.2% (n = 68) underwent surgery. Several surgical procedures were necessary in 4 cases (2.1%). AM recurrences requiring a second hospitalization were observed in 8 patients (4.3%). The only observed complication was lateral sinus thrombosis (n = 6; 3.2%). Surgical failures, requiring more than one surgical procedure, were more frequent in case of: (i) presence of Anaerobes (p ≤ 0.001) or Gram-negative bacteria (p ≤ 0.05) in microbiological samples; (ii) surgical drainage without mastoidectomy (p ≤ 0.001). Recurrences were more frequent in AM due to Streptococcus pneumoniae.

Conclusions

Based on our findings and on literature data, a protocol was established in order to standardize the management of pediatric AM in our center. The mains points are: no systematic surgery; if surgery is indicated, it must encompass a mastoidectomy; broad-spectrum intravenous antibiotic treatment covering the most commonly involved germs (3rd generation cephalosporin) and secondarily adapted to the results of microbiological samples. If the infection is not controlled after 48 h of intravenous antibiotherapy, a mastoidectomy had to be performed.     

Acute mastoiditis in children: the "Ferrara" experience

OBJECTIVE: This study aims to investigate the clinical features and outcomes of acute mastoiditis in children referred to the ENT/Audiology Department of the University of Ferrara from January 1994 to December 2005. It also aims to discuss risk factors and to find predictors for surgery. METHODS: A retrospective study on case sheets of children with an acute mastoiditis diagnosis was carried out. Fifty-five cases fulfilled the inclusion criteria: they presented otoscopical evidence of acute otitis media and inflammatory findings of the mastoid area such as post-auricular swelling, redness or tenderness, protrusion of the auricle and/or radiological findings. RESULTS: Twenty-six patients were only treated with antibiotic therapy, tympanocentesis alone was performed in 11 cases; in 5, a ventilation tube was positioned. Mastoidectomy was performed in 13 patients. The group who underwent mastoidectomy had a median hospital stay of 15 days (5-54), in this group were found the following complications: 1 meningitis, 1 meningo-encephalitis, 1 lateral and sigmoid sinus thrombosis, 1 facial palsy. CONCLUSION: the incidence of otomastoiditis does not seem to be decreasing, on the contrary, in some countries, it seems to be on the increase. Our experience cannot confirm a real increase of the incidence but we noted periodic variations during the time of observation. It is important, that careful attention is paid to the clinical assessment of children who are 2-years old or under, as they seem to be more exposed to the risk of clinical complications; therefore, it is highly recommended that the otologist and the paediatrician collaborate closely.     

Acute myelogenous leukemia presenting as atypical mastoiditis

Acute leukemia presenting as otitis media is a rare presentation of the disease [1], [2], [3], [4], [5]. We present a patient that was diagnosed with acute myelogenous leukemia (AML) who had signs and symptoms of acute otitis media and mastoiditis. His workup revealed granulocytic sarcoma involving the superior sagittal sinus, sigmoid sinus, internal jugular vein, and parotid gland. This extensive involvement of granulocytic sarcoma has not been described. This case report highlights the importance of complete hematologic and radiologic workup prior to consideration for surgical intervention for mastoiditis.     

Acute mastoiditis: a review of 34 patients

A review of 34 patients presenting with acute mastoiditis was undertaken. Prior treatment was noteworthy for lack of medical or surgical drainage at the time of initial otitis media. Typical findings, in hospital, included postauricular edema and tenderness, displaced auricle, and distorted tympanic membrane. X-rays were not diagnostic, nor were they helpful in determining who was a surgical candidate. Treatment was individualized. Patients with obvious subperiosteal abscesses, and those who did not respond rapidly to enteric antibiotics, underwent early mastoid surgery. The remaining patients received enteric antibiotics, had drainage established, and were carefully followed. Most resolved without mastoid surgery. Patients with a history of antecedent ear disease were examined separately from those without such history. The former group required mastoid surgery more often than the latter and had poorer outcome.     

Acute mastoiditis: a 10 year retrospective study

This retrospective study reviews our experience in the management of acute otomastoiditis over 10 years. During the study period we identified 40 cases in children aged 3 months-15 years with a peak incidence in the second year of life. Sixty per cent of them had a history of acute otitis media (AOM). All the children were already receiving oral antibiotic therapy. Otalgia, fever, poor feeding and vomiting were the most common symptoms, all the children had evidence of retroauricolar inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used to support the diagnosis and to evaluate possible complications. Streptococcus pneumoniae was the most common isolated bacterium. All the patients received intravenous antibiotics, 65% of children received only medical treatment, 35% also underwent surgical intervention. Mean length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child. We conclude from our study that acute otomastoiditis is a disease mainly affecting young children, that develops from AOM resistant to oral antibiotics. Adequate initial management always requires intravenous antibiotics, conservative surgical treatment with miryngotomy is appropriate in children not responding within 48 h from beginning of therapy. Mastoidectomy should be performed in all the patients with acute coalescent mastoiditis or in case of evidence of intracranial complications.     

Acute mastoiditis in infants

We present a retrospective study of 37 infants who were operated for acute mastoiditis during the period 2000–2004 in Mother and Child Health Care Institute, Belgrade, Serbia and Montenegro. About 23 patients (62.2%) were male and 14 (37.8%) were female. Acute mastoiditis developed just after the first infection of the middle ear in 26 patients (70.3%). All patients had local and general symptoms. The most common local symptoms were blurred tympanic membrane in all patients, painful tenderness of mastoid in 21 (57%) and redness of tympanic membrane in 13 (36%). General signs of infection were loss of body weight in 28 (75.7%) patients, fever in 21 (56.8%), vomiting in 19 (51.3%), diarrhea in 19 (51.3%) and severe anemia that requested red blood cell transfusion in 6 (16.2%). Suppuration did not appear in any of the patients. Tympanocentesis had been performed prior to surgery in all patients. The most frequently isolated causative microorganism was Streptococcus pneumoniae which was found in 12 (32.5%) patients, Staphylococcus aureus was found in 8 (21.5%) and Hemophilus influenzae in 2 (5.5%). In 15 (405%) patients there was no bacterial isolation. Eleven patients (29.7%) who had previously had acute otitis media were implanted ventilation tubes during the surgical intervention. All patients were treated with antibiotics prior and after the surgical intervention. The finding on mastoidectomy was positive in all cases. According to the results of our study the combination of antibiotic and surgical treatment is optimal in treating acute mastoiditis. Making a diagnosis of acute mastoiditis might not be easy since there are no specific symptoms. We emphasize that it should always be considered as a differential diagnosis in cases of prolonged acute otitis media with no improvement after 10 days of antibiotic treatment, especially when accompanied with weight loss and general condition worsening.     

Acute mastoiditis in children, a retrospective analysis about a period of 25 years

BACKGROUND: During the last years the classical signs of the acute mastoiditis have changed. Aim of the following study was to examine the change of symptoms as well as the change of incidence. METHODS/PATIENTS: The records of 113 children who received mastoid surgery due to acute mastoiditis were retrospectively investigated. Data covered a regional group of patients during a period of 25 years (1979 - 2003). RESULTS: Considering the drop of the birthrate from 1991 in the East German countries, there was a significant increase of the incidence of acute mastoiditis. The patients had a mean age of 2,5 years. The classical symptoms like "retroauricular swelling, tenderness and protrusion of the auricle" were only noted by 47 children (41.6 %). Preoperative complications appeared as facial palsy, abscess and septic lateral sinus thrombosis in 11 children. Bacterial cultures, taken during surgery yielded in 55.7 % Streptococcus pneumoniae. The therapy contained a surgical intervention combined with antibiotics. CONCLUSIONS: An early surgical treatment by mastoidectomy or antrotomy supported by antibiotics represents the safest method to avoid complications.     

Acute mastoiditis: predictors for surgery

To estimate the incidence of acute mastoiditis and identify predictors for mastoid surgery, a retrospective case record study of 38 children hospitalised for acute mastoiditis in Oslo from 1989 to 1998 was performed. Median age at diagnosis was 18 months and 13 (34%) of the children received mastoidectomy. Compared to the period 1970-1979, the incidence of mastoidectomy was significantly reduced. Only seven children (18%) had experienced acute otitis media prior to the current episode. Symptom duration of 6 days or more prior to hospitalisation and elevated white blood cell counts and C-reactive Protein were predictive for mastoidectomy ((OR = 5.0 (1.0-22.8), (OR = 24.5 (2.5-240) and OR = 10.5 (1-108.8)). Furthermore, total time from symptom onset to hospital discharge was significantly higher in children who received mastoidectomy. We suggest early referral to an otolaryngologic department in children suspected of acute mastoiditis.     

Acute mastoiditis in children--our experience

The incidence of acute mastoiditis and the number of complications has changed since the 1950s, despite the increasing antibiotic effectiveness. Other series concluded that the incidence of acute mastoiditis is rising in the recent years, which can be justified by the antibiotic resistance of the microorganisms and the absence of paracentesis in the treatment of acute otitis media. Our aim is to approach risk factors, clinical presentation, diagnosis and treatment of acute mastoiditis. We reviewed 62 clinical records of patients in pediatric age, observed in D. Estefania Hospital Lisbon, between January 1993 and December 1997. There was a relative homogenous distribution during the 5 years of the study period. The patient age ranged from 5 months to 14 years. They all were treated with intravenous antibiotics. The mean duration of treatment was 7.4 days. We registered 15 complications: 14 retroauricular subperiosteal abscesses and one subdural empyema. The most common isolated microorganism was Streptococcus pneumoniae. We found no statistic difference (P > 0.1) in the incidence of acute mastoiditis between the 5 years of the study.     

Acute mastoiditis in children. A retrospective study and literature review

ObjectiveTo review our experience and results in the diagnosis and treatment of acute mastoiditis, a pathology with an increasing incidence in the recent years.MethodsThe study reviewed 49 pediatric patients diagnosed and treated of acute mastoiditis between 1994 and 2003 in our hospital. We summarize epidemiologic, laboratory and clinical features.ResultsThe mean age was 2.5 years. Seventy-five percent of cases were in autumn and winter months and nearly twenty-five percent had been diagnosed in the last year. S. pneumoniae was the most commonly isolated pathogen (28.6%), although a sterile result was the most frequent (38.1%). Twenty-four patients (48.9%) required surgical treatment. Only five patients (10.2%) developed complications.ConclusionsAcute mastoiditis is a pathology with an important incidence and is generally the consequence of an untreated otitis or an insufficient treatment. Due to the low number of complications, we can not estimate through statistical analysis valid markers like predictors for complication.     

Acute mastoiditis in a Norwegian population: a 20 year retrospective study

We have retrospectively examined the nature of acute mastioditis (in western Norway) during a 20 year period (1980-2000). Sixty-one cases of AM were identified in 57 patients with a mean age of 3.6 years. We found no significant change in the incidence of AM during the last 20 years. Seven patients were treated solely with intravenous antibiotics and myringotomies. Fifty patients also underwent cortical mastoidectomy, four cases with bilateral surgery. Antibiotic treatment was given to 31 of the patients before admission to hospital and this group had a significant longer duration of symptoms (12.4 days) compared to untreated patients (7.3 days). Streptococcus pneumoniae was the most common organism recovered from patient cultures. Surgery was found to correlate to patients with retroauricular fluctuation or to children with at least two of the three clinical signs: protrusion of the ear, retroauricular oedema and swelling of the ear canal. Our data show that clinical examination only reveal 50% of the cases with surgically proven retroauricular subperiostal abscess. We therefore recommend a CT scan of patients treated conservatively.     

Acute myelogenous leukemia presenting as atypical mastoiditis with facial paralysis

Symptomatic otologic involvement by leukemic infiltration is unusual, most often occurring in the already-diagnosed leukemic patient as postauricular mass, acute hemorrhagic otitis media, mastoiditis, cranial neuropathy, vertigo, hearing loss, or leptomeningitis. We think ours is the first reported patient whose leukemia presented as atypical mastoiditis and facial paralysis due to granulocytic sarcoma (chloroma). At mastoidectomy, tan lobulated rubbery tumor filled the mastoid antrum and middle ear cleft. Complete remission and full return of facial nerve function was achieved with 2500 R local radiation and systemic chemotherapy. We discuss the role and extent of surgery in atypical acute mastoiditis when unsuspected middle ear and mastoid tumor, with inconclusive intra-operative histopathologic data, is found.